Health Committee

June 9, 2004 – 10:00 a.m.

DRAFT Minutes

Members present: Dr. Paul DiGiovanni, Chairman; Larry Cornell, Vice Chairman; Mike McKee; Tamara Wyant, Newell Willcox; Carol Tytler; Scott Steve, Chairman of the Legislature

Others present: Ann Homer, Jackie Gailor, Public Health Director; Linda Medeiros, Administrative Officer – Mental Health; Scott Schrader, County Administrator; Cathy Feuerherm, Health Department; MJ Uttech, Deputy Public Health Director; Annette Barber, Deputy Personnel Officer; Julie-Boden-Schmidt, Executive Director, Family Health Network

Absent: Steve Dafoe

Dr. DiGiovanni called the meeting to order at 10:07 a.m.

On the motion of Mr. Cornell, seconded by Mr. Willcox. All members voting in favor; none opposed; minutes approved as printed.

RESOLUTIONS:

1. Approval to Fill Above Midpoint, Health Department (Director of Patient Services) – Mrs. Tytler moved adoption, seconded by Mr. McKee. Mrs. Gailor explained that the goal of this is to fold Children with Special Needs back in to Nursing where it originally was placed. Ms. Feuerherm has applied for the DPS position and she is fully qualified for the position. Ms Feuerherm is currently at a lower grade level but off the scale. The intent is not to fill the Director of Children with Special Needs position at this time. This resolution would give Ms. Feuerherm approximately an $800 raise. Chairman Steve indicated that Ms. Uttech is assuming this responsibility currently. Chairman Steve feels that it makes sense to put an individual in this position who understands our system and he supports this resolution. Chairman Steve feels that the entire Health Department structure needs to be evaluated and Mrs. Gailor agrees. Ms. Feuerherm was told that one of her goals in accepting this position is to have the CHHA reach the point where it is not operating in a deficit situation. She feels she is up to that challenge. This position has been vacant since last year. Chairman Steve complimented the department on having an open mind to look at the structure differently. Mrs. Tytler asked if Management Compensation has looked at this position with this individual to evaluate a salary. Chairman Steve indicated that this is not a new position, so that process would not be required. We evaluate new positions in that light. Mrs. Tytler asked if this individual meets all the qualifications. Mrs. Gailor indicated that she meets all the requirements and more, as Ms. Feuerherm has a Master’s Degree. Dr. DiGiovanni asked that if this a part of a reorganization, when will we be closely looking at the reorganization. Chairman Steve indicated that a portion of this position will be looking at the requirements and necessities of the division and help guide where the reorganization will go. Dr. DiGiovanni indicated that he is not opposed to this, but he feels we may be getting the cart before the horse and he would like assurance that we will look at a reorganization. Mr. Schrader indicated that there is an understanding about this process. Budget packages will be going out very shortly and if the Health Department submits a request for Ms. Feuerherm’s current position, they will have to justify it. Dr. DiGiovanni asked where the Health Committee fits in to this. Mr. Schrader indicated that committees have been meeting with departments regarding their budget submissions, so the committee would review the budget at that time. Mrs. Tytler inquired whether this is asking too much of one person. Mrs. Gailor indicated that previously the CHHA has not operated with a deficit until we had the year with the bad survey. There is understanding that if the deficit operation is not corrected, the CHHA program will not continue. Ms. Uttech will work closely with Ms. Feuerherm for a minimum of six months and longer if needed. Ms. Feuerherm approached Mrs. Gailor about this, and Mrs. Gailor said Ms. Feuerherm feels she is up to the challenge. We won’t know until we try this. Dr. DiGiovanni feels in terms of what we are doing in a narrow focus with this agenda item. From an economic point of view, we state that organization is going to be looked at. Mr. Schrader indicates that it will be done in the budget process. Dr. DiGiovanni wants that organization/structure to be looked at by the committee as well, so that if this is approved, there is an expectation that Ms. Feuerherm will be required to report back to this committee on what has been accomplished since the last meeting. Mrs. Gailor responded that this has been an expectation and it has always happened. Dr. DiGiovanni feels there is an expectation that in the additional role that Ms. Feuerherm will be assuming, one of her prime responsibilities is to look at the position she is vacating and recommend to the committee what should be done with that position. Mrs. Tytler would like to see a re-evaluation of this job, since it is no longer the DPS position as it was. Mr. Willcox asked what happens if the resolution is approved. Is it cast in stone. Mrs. Gailor responded that once the resolution is adopted, Ms. Feuerherm is appointed to the position. Dr. DiGiovanni indicated that we need to have a DPS. We can re-define the expectation/duties of the position. He doesn’t feel we need, however, to have separate division heads. All members voting in favor; none opposed; motion adopted.

Related to this discussion, Chairman Steve distributed a letter from NYSNA relative to the CHHA. Mr. Schrader explained the correspondence. There is an alternative work schedule built in to the NYSNA Contract. Generally speaking, the MOU was requested by management because of the short staff positions we had in the CHHA as it relates to nursing. Because of the short staffing, our nurses were having to work weekends every other week and we had to pull normal weekend people off to cover days of the week. This was done as a stop-gap measure to bide us some time to come up to full staff. That has happened with one vacancy that has not been filled. That being said, two vacancies were filled in May, so the employees have not been oriented and therefore cannot handle on call. The request is to extend this MOU until the end of the year. In his mind, the most compelling reason is to give Ms. Feuerherm the opportunity to fully evaluate the requirements for week day/weekend coverage. Ms. Feuerherm needs to be provided this opportunity. Mrs. Gailor indicated that even though the correspondence reflects her name, she has never signed one, it has always been the Personnel Director. This provides the opportunity for the new DPS to fully evaluate requirements and to get all staff fully oriented. Ms. Uttech indicated there are currently two vacancies but there are two individuals ready to step in. We have received one resignation and we know that one more is forthcoming. Ms. Feuerherm indicated that the two candidates will most likely begin in July. She would like to not bring on any more orientees until those two individuals are oriented. Mrs. Gailor indicated that this is also prime vacation time. We only allow two nurses off per week, but staffing is down two nurses just about every week from May to September. Mr. McKee asked how long orientation is. Ms. Uttech indicated that it is normally at least six months before the person can become primary on call – carrying the beeper, etc. At about six weeks, they start building up the caseload. At about four months, they are up to speed in handling a full caseload, but they are not considered fully oriented for six months. Mrs. Gailor explained that we need to make certain the orientation is complete and appropriate so they fully understand the position – exactly what they must do and how to document it completely so we are in compliance with the survey. Ms. Feuerherm indicated that the orientation period should also be utilized to weed out those individuals who simply cannot do the job. Ms. Uttech indicated that she feels the recent hirees and the individuals anticipated to hire in July will be superior candidates. Dr. DiGiovanni asked about the financial impact of the MOU. Mrs. Gailor indicated that there is no negative financial impact and in fact may result in a cost savings. Mr. Schrader indicated that if we were fully staffed, we would be losing money. But given the fact that we are not fully staffed, there is no financial impact. Dr. DiGiovanni asked how you extend an agreement on July 1, 2004, that expired on December 31, 2003. The explanation was the MOU was previously extended and will expire on June 30, 2004. Mrs. Gailor explained the extension is to make certain we have enough staff to cover all seven days – and yes, vacation does add to the staffing crisis. Mr. Cornell moved that the Chairman of the Legislator sign the agreement extension for six months. Seconded by Mrs. Tytler. All members voting in favor; none opposed; motion adopted.

2. Authorize Agreements, Health Department (Public Health Emergency and Preparedness Plan) – Mr. Cornell moved adoption, seconded by Mrs. Tytler. All members voting in favor; none opposed; motion adopted.

3. Authorize Agreement, Health Department/Environmental Health (Pesticide Application for Mosquito/Larva Control) – Mr. McKee moved adoption, seconded by Mr. Cornell. Mr. Cornell asked if we were still receiving grant money. Mrs. Gailor indicated that we received grant money only the first year. However, once we have a positive bird, the reimbursement rate increases from 30% to 50%. Mr. Schrader indicated that he is not a fan of this program. Why would we do this prior to receiving notification of a positive bird. Mrs. Gailor explained that because it is a preventive measure. Once you have a positive bird, you have West Nile in the community. Mr. Schrader asked what the point is given the life cycle of the mosquito and the fact that this application is only good for 30 days. Mrs. Gailor explained that we would apply ever 30 days if the conditions are right. Mr. Willcox asked why we don’t do this in-house. Mrs. Gailor responded that because we don’t have staff who are licensed pesticide applicators. It is costly in the long run and results in additional insurance requirements. She doesn’t feel it would be cost effective for us to do this. Mr. Willcox asked if we could table this until he receives more information. Mrs. Gailor indicated that if we table it, we could be well in to the season. Mrs. Gailor indicated that this is the bare minimum to protect us against the West Nile Virus. No, we don’t have to do it, but if we wait until there are numerous birds in the community, that is the period when the human infection takes place. Mr. Cornell asked if we decide not to do this and someone gets sick and dies, what is our exposure? Dr. DiGiovanni indicated that we don’t have human West Nile Virus. He feels we are being asked to make a decision without adequate information. Ms. Wyant asked what other counties are doing. Mr. Schrader said there is a variety of options counties are taking depending on what is happening in the county at the time. Mr. Schrader indicated that this is basically a risk assessment. Mrs. Gailor indicated that this resolution authorizes us to sign a contract, it does not require us to use the contract. If we decide to wait until we have a positive bird, we have to go through this procedure at that time and the contractor may not be available to spray. Mrs. Gailor suggested that the committee might wish to move to restrict spraying until a positive bird is found. Dr. DiGiovanni indicated that we have this committee and we have a Board of Health. Where is the input? Mrs. Gailor indicated that the Environmental Health Division originally presented all the information to the Board of Health and it was their recommendation that we follow this process. We have continued with that procedure. Mr. Schrader indicated that he feels that the policy needs to be reviewed, but in his opinion, we need the ability to react when we need to react. When we need to react needs to be discussed through this committee and through the Board of Health. Dr. DiGiovanni indicated that he has continually expressed that the Board of Health needs to set policy and the policy needs to be current. The Board of Health should be providing information on why they feel this is the direction in which we need to move. The other observation he will make it that there are "celebrity viruses" that are in the news so they get much attention. Mrs. Tytler asked if we tie our hands if the contract is not in place. Mr. Schrader indicated that if the contract is not in place, we will not be able to react immediately and will have basically at least a 45 day waiting period. If a response is needed and appropriate, she does not want to be able to react. All members voting in favor; none opposed; motion adopted.

4. Increase Hours, Mental Health Department (Certified Social Worker) – Mr. McKee moved adoption; seconded by Mr. Cornell. Mrs. Medeiros indicated that this resolution, as well as resolution number 5, is a temporary measure until staffing is at full levels. Mrs. Medeiros indicated that the current wait period for adults is two months. The wait period would be less if this resolution and number 5 are adopted. In an emergency, clients are seen within five working days. Ms. Wyant asked if it would be more cost effective to have a full-time staff member to handle emergencies instead of utilizing the hospital. Ms. Medeiros indicated that we do not have a staff member who can sit idle and wait for the emergency to walk in the door. She also explained that part of the CMH contract is to evaluate whether or not the patient needs in-patient treatment. Mr. Schrader indicated that one of the things he has asked Mrs. Medeiros to look at is that if we eliminate the waiting list, could be make the clinic more profitable – resulting in a break even situation. All members voting in favor; none opposed; motion adopted.

5. Authorize Agreements, Mental Health Department (Consulting Psychologist) – Mr. Willcox moved adoption, seconded by Mr. Cornell. Dr. DiGiovanni indicated that he is supportive of this resolution; however, he is unhappy with the process we are following to address problems such as these. All members voting in favor; none opposed; motion adopted.

DISCUSSION/PRESENTATIONS/DISTRIBUTIONS:

1. Dental Health – Family Health Network – Dr. DiGiovanni explained that the discussion is about the location/relocation/expansion of the dental clinic. This has been addressed with Seven Valleys Health Coalition and the Board of Health. Ms. Julie Boden-Schmidt, Executive Director of Family Health Network spoke to the group and explained the make up and purpose of FHN. She provided an historic overview of the dental clinic. The clinic originated in Cortland County but because of physical location problems, it was moved to Groton. 77% of the dental patients come from Cortland County. The target population is the working poor on Medicaid. In addition to provide better customer service, to increase FHN’s productivity, the relocation to Cortland County will also help attract dentists, who will come up/down Route 81 from Binghamton/Syracuse, but will not go off the main route to get to Groton. FHN is now in the position of looking for funding to relocate the clinic. The building is available, the landlord is willing to make the renovations in the building and include that in the long-term lease, but the problem is the old equipment. The City will make a decision next week about a long-term loan that FHN can swing. Dr. DiGiovanni asked what FHN is asking for the County. Ms. Boden-Schmidt is initially asking for the Legislature to support it – not necessarily financing, but vocally. However, if the County can provide any financial support, it would be greatly appreciated. Thoma Development is making a proposal to the Common Council on FHN’s behalf to receive the long-term, low-cost loan. At a minimum, FHN is looking for $25,000 to subsidize this program. Mrs. Gailor indicated that she feels this is the primary health care need in Cortland County – dental health care for low income. Ms. Boden-Schmidt indicated that a lease must be signed by early July, with the intent to move in the facility in the late fall. Equipment needs to be purchased by October 1. Dr. DiGiovanni would like to see some pro-forma financials from FHN or a business plan. Ms. Boden-Schmidt will provide financials to Mrs. Gailor by Monday. Dr. DiGiovanni asked how the local dental community is receiving this. Ms. Boden-Schmidt indicated that the local dental community has been contacted twice. They basically have said that dental health for the low income community is a public health issue not a private provider problem. They have not responded to a plea for help when one of the FHN dentists was called to military duty. Ms. Boden-Schmidt believes part of this reticence is due to the local dental community’s fear of competition. She does not believe this will compete with the private practices because they will basically serve a different population. Dr. DiGiovanni would like to proceed, if possible, with the local dental community’s support. If they are opposed, he would like to understand why.

2. Update on Children With Special Needs (CSN) – Speech Language Pathologist – Mrs. Gailor indicated that we do not have a signed contract with CMH. As of Monday, it was still awaiting County Attorney approval. Dr. DiGiovanni indicated that there is .75 FTE available to start immediately. There are four PreK children in need of Speech Pathology – one has been on the waiting list until last September. They will not get it now until fall. There was one person who worked for the school system, but we can’t sign contract with her until she reinstates the license which she had let lapse.

3. Update on the CHHA Plan of Correction – Mrs. Gailor reported that all in-services have been provided; the routine chart-audits are on-going; other areas of concern are being addressed continually. The updated computer system is helping "catch" items that were not caught before.

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